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01-02-2017 | Original

Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome

Authors: Nicolas Nin, Alfonso Muriel, Oscar Peñuelas, Laurent Brochard, José Angel Lorente, Niall D. Ferguson, Konstantinos Raymondos, Fernando Ríos, Damian A. Violi, Arnaud W. Thille, Marco González, Asisclo J. Villagomez, Javier Hurtado, Andrew R. Davies, Bin Du, Salvatore M. Maggiore, Luis Soto, Gabriel D’Empaire, Dimitrios Matamis, Fekri Abroug, Rui P. Moreno, Marco Antonio Soares, Yaseen Arabi, Freddy Sandi, Manuel Jibaja, Pravin Amin, Younsuck Koh, Michael A. Kuiper, Hans-Henrik Bülow, Amine Ali Zeggwagh, Antonio Anzueto, Jacob I. Sznajder, Andres Esteban, for the VENTILA Group

Published in: Intensive Care Medicine | Issue 2/2017

Abstract

Purpose

To analyze the relationship between hypercapnia developing within the first 48 h after the start of mechanical ventilation and outcome in patients with acute respiratory distress syndrome (ARDS).

Patients and methods

We performed a secondary analysis of three prospective non-interventional cohort studies focusing on ARDS patients from 927 intensive care units (ICUs) in 40 countries. These patients received mechanical ventilation for more than 12 h during 1-month periods in 1998, 2004, and 2010. We used multivariable logistic regression and a propensity score analysis to examine the association between hypercapnia and ICU mortality.

Main outcomes

We included 1899 patients with ARDS in this study. The relationship between maximum PaCO₂ in the first 48 h and mortality suggests higher mortality at or above PaCO₂ of ≥50 mmHg. Patients with severe hypercapnia (PaCO₂ ≥50 mmHg) had higher complication rates, more organ failures, and worse outcomes. After adjusting for age, SAPS II score, respiratory rate, positive end-expiratory pressure, PaO₂/FiO₂ ratio, driving pressure, pressure/volume limitation strategy (PLS), corrected minute ventilation, and presence of acidosis, severe hypercapnia was associated with increased risk of ICU mortality [odds ratio (OR) 1.93, 95% confidence interval (CI) 1.32 to 2.81; p = 0.001]. In patients with severe hypercapnia matched for all other variables, ventilation with PLS was associated with higher ICU mortality (OR 1.58, CI 95% 1.04–2.41; p = 0.032).

Conclusions

Severe hypercapnia appears to be independently associated with higher ICU mortality in patients with ARDS.

Trial registration

Clinicaltrials.gov identifier, NCT01093482.

Available only for authorised users

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Title: Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome
Authors: Nicolas Nin
Alfonso Muriel
Oscar Peñuelas
Laurent Brochard
José Angel Lorente
Niall D. Ferguson
Konstantinos Raymondos
Fernando Ríos
Damian A. Violi
Arnaud W. Thille
Marco González
Asisclo J. Villagomez
Javier Hurtado
Andrew R. Davies
Bin Du
Salvatore M. Maggiore
Luis Soto
Gabriel D’Empaire
Dimitrios Matamis
Fekri Abroug
Rui P. Moreno
Marco Antonio Soares
Yaseen Arabi
Freddy Sandi
Manuel Jibaja
Pravin Amin
Younsuck Koh
Michael A. Kuiper
Hans-Henrik Bülow
Amine Ali Zeggwagh
Antonio Anzueto
Jacob I. Sznajder
Andres Esteban
for the VENTILA Group
Publication date: 01-02-2017
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 2/2017
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-016-4611-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome

Abstract

Purpose

Patients and methods

Main outcomes

Conclusions

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Patients and methods

Main outcomes

Conclusions

Trial registration

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